Baby-CPR: Full Circle

The first time I partook in a baby’s resuscitation was during my fourth year of medical school. It was a disaster: the wall-suction malfunctioned, the nursing staff were in the precarious business of changing shifts, and all algorithms flew out of the window.

I vowed optimistically that when I was a doctor, I would not let a baby die that way.

I had a lot of criticisms, which is so easy for a student to do; but I did learn from it. I learned to prepare myself mentally for any scenario where a life may need to be saved, so that I could give that life a fighting chance.

Last night it was my turn. I was called to the ward for a desaturating baby with pneumocystis carinii pneumonia (PCP). It was my call to start bag-mask ventilation, and then to start compressions when his heart rate dropped below 60.

Chest X-ray of a child with PCP. European Respiratory Journal. Click for link.

I have not done formal APLS, and I had to draw on every bit of information I recall from medical school training. (I’ve only been doing paediatrics for a week now.)

But it was a beautiful resuscitation. Even though the nursing staff were also changing shift (why does it always happen like that?) they were in top-form. Anything I asked for was there. And when I asked for my senior, she arrived too.

The wall-suction worked. The intubation tray was ready. The adrenaline was prepared correctly.

It was our first time doing a resuscitation together, but we worked like a well-oiled machine. No single person could take credit: it was a matter of everything coming together as it should.

Not to say that there is nothing I would do differently, of course. But after mulling over every action for the past 24 hours, I realise we did not miss anything that could have meant the difference between life and death.

And still, the baby died.

My fingers felt it when his tiny heart stopped beating. They probed searchingly, full of hope for it to start again.

It did not.

We resuscitated for more than an hour.

I really did believe that the resuscitation would be successful. In the moments between deciding to start full-blown CPR and actually doing so, I banished my self-doubt and focused only on the child.

And so I learned a new lesson last night: that, even when you do everything “right”, you may still fail.

That’s so, so sad, isn’t it? I’ve had to take a couple of my children to the hospital; once the youngest had croup, and I was really worried about him, because he was finding it so hard to breathe… yet when I got there, I relaxed completely. Here, they could take care of him. We were safe! And they gave him some steroids, and put my mind at rest, and my child got better. Lucky us.

I think sometimes we still imagine that hospitals are magical places where everything will be fine, and sometimes it’s just not. I’m so sorry that the baby died, and I’m sorry for the family and for you all who tried to save him. Big hugs.

Thank you. Croup can be quite scary, but it responds well to treatment; I’m so glad your child got the care he needed.
Yeah, there is an interesting sociology of hospitals, and it runs in a cycle – like how years ago people were afraid of hospitals because they were essentially palliative, and then hospitals became places of healing, but I think right now, at least in South Africa, hospitals are becoming a place of fear again because so many patients “come here to die”.
Thank you for your supportive message ❤

It really depends on the team dynamics at the time. Some people feel the most senior team member should always break the news, but we feel that the person who has built rapport with the patient should do so. Language also plays a role, because if you don’t speak the patient’s language it’s not really nice for them to hear it second-hand. At our hospital, it often happens that the nurse brings the patient in and breaks the news to her, and then gives her the opportunity to ask the doctors questions. In this particular case, the senior doctor asked to break the news because she had also done the baby’s admission and had a good rapport with the mother.

As a current 4th year medical student, my first week of internal medicine rotations while on call had me feeling the same way you felt during your medical training. Although I’m still in IM and have participated in 4 codes so far I always pray and hope for a successful resuscitation. I was hoping this post would have ended on a happier note but you’ve made me realize that the end of it all, death is still apart of living and no matter how much we would hope these things would go smoothly and life would resume as normal sometimes they don’t.

I read this while holding my 8 month old who required full resuscitation at birth and two rounds of CPR. I know practicing on other babies who didn’t always make it meant she is her with me today. Thank you.